Re: Cigna (TX) Not Covering Band - Anyone Else

[Guest guest]

Hi Tammy,

I have Cigna (VA.) too and there is an exclusion in py policy and they

do not cover this.

I still want to go through with it to help my son. I was thinking of

filing an appeal.

>

> Has anyone else had issues with Cigna not covering the band? They are

> telling me they only cover the band for post-surgical use.

>

> Please advise,

> Tammy

>

[Guest guest]

I plan on filing an appeal but I'm also looking into my Flex Spending

plan at work. We're also planning on moving forward with it all. The

jury is still out on that so I'll let you know what I find out. I'll

keep you posted so feel free to email me.

Have you scheduled your apptfor the casting yet?

Tammy

> >

> > Has anyone else had issues with Cigna not covering the band? They

are

> > telling me they only cover the band for post-surgical use.

> >

> > Please advise,

> > Tammy

> >

>

[Guest guest]

Check carefully on your policy. They may have an exclusion policy, but we did get Cigna coverage (although it was in 2000). They denied us on lack of posterial therapies (repositioning), absense of craniosynostosis or any other neurological abnormalities (though he looked exactly like he had sagittal cranio (long and narrow in shape), as well, they threw in that they thought it was cosmetic and as such was not a covered benefit. (Yep, they hit us with three things to refute.)We appealed based on the fact that the doctors thought he had cranio because of his headshape, and if they would cover the band after surgery to acheive a normal headshape, why wouldn't they cover it when no surgery was necessary. Additionally he could not lay in a normal position (his head pushed his chin to his chest), and this was noted in his letter of medical necessity. We included medical information (he was breech, and large at birth), reposit

ioning photos (we used a towelor mini boppy besind his neck so he could lay on his back), as well as progression photos (his shape really did not improve past month 3). These I imported to a word document, so I only included 4 pages of pictures (about 4 pictures per page), but they were labled. I also included a drawing of a child with sagittal cranio to show how similar in headshape it was.I know ours was a strange case because of his headshape being so close to sagittal cranio, but I would still encourage you to at least go through your insurance information, and note any specific exclusions, and make an appeal if there is even a glimmer you could get through. If the insurance company covers things like breast reconstruction after breast cancer surgery or other similar reconstructions, you may be able to wiggle in. There are some very informative letters in the files section on this website. Be sure to find the AMA resolution about

cosmetic therapies -- that has also been used in many appeals packages, though it might have been updates since 2000.I also have an information page, which might be slightly outdated, that I put together in 2000 -- which can be found on a website called Parrent Support (the page is under Insurance Issues) http://www.plagiosupport.org/ Good Luckaka "Kali"Mom to Quinn, born 11/99, DOCband grad 10/00.>------- Original Message ------->From : holdenhl[mailto:holdenhl@...]>Sent : 3/25/2008 9:07:00 AM>To : Plagiocephaly >Cc : >Subject : RE: Re: Cigna (TX) Not Covering Band - Anyone Else>>Hi Tammy,I have Cigna (VA.) too and there is an exclusion in py policy and they do not cover this.I

still want to go through with it to help my son. I was thinking of filing an appeal.>> Has anyone else had issues with Cigna not covering the band? They are > telling me they only cover the band for post-surgical use. > > Please advise,> Tammy>------------------------------------For more plagio info

[Guest guest]

Thank you so much. I'll look into all of this.

Tammy

> >

> > Has anyone else had issues with Cigna not covering the band? They

are

> > telling me they only cover the band for post-surgical use.

> >

> > Please advise,

> > Tammy

> >

>

>

>

> ------------------------------------

>

> For more plagio info

[Guest guest]

Thank you for sharing your information ! I came across your

info page awhile ago and I think it's great!

> > >

> > > Has anyone else had issues with Cigna not covering the band?

They

> are

> > > telling me they only cover the band for post-surgical use.

> > >

> > > Please advise,

> > > Tammy

> > >

> >

> >

> >

> > ------------------------------------

> >

> > For more plagio info